A change in position

The Alliance for Better Access is now five years old. Across those years we have done almost everything you can imagine to help our politicians understand the need to improve the mental health policies of Medicare (meetings with both sides of government, petitions, youtube clips, radio interviews, television, email campaigns, memes, etc). Our position has gradually evolved over time to align with feedback and current debate in the mental health care sector. Now it’s time for us once more to pause, reflect on where we are presently at, and decide what our position is currently.

In 2011 we formed the Alliance for Better Access to stop Labor from cutting the Better Access to Mental Health Care program. We were unsuccessful, which meant that Medicare support for psychological care was reduced from an upper limit of 18 appointments down to just 10 visits. After several years of campaigning, with little effect, we changed our position. We developed a detailed model of psychological care based on treatment guidelines and dose-response studies. Our revamped model recommended access to at least 15 to 20 visits of psychological care for the treatment of common mental disorders. By costing our proposal and linking it with the best research data available, we hoped that our political leaders would hear us. As many of you would know, Australia’s Medicare system still covers just 10 visits.

Several recent reports have called for better access to therapy. We told the National Mental Health Commission that ten visits were not enough in 2014 which resulted in a clear expression of public and expert opinion. Statements across the volumes of the report confirmed our view that the number of sessions of psychotherapy people can access should be based on complexity and individual need rather than a predesignated number of appointments. The recent Royal Commission redress and civil litigation report into institutional child sexual abuse states that symptom-based criteria are not a useful way to decide who should be eligible to access to psychological care. It recommends that Medicare support for psychological care should not require a diagnosis and that there should not be restrictions on the number of counselling sessions available. These principles of mental health care for trauma survivors are appropriate, not only for survivors of childhood trauma, but also for the wider public. If we are going to address mental health problems early in our society, then we need to help people connect with those who can support them.

On that basis we have asked members of the Alliance for Better Access whether we should change our position to reflect these calls for more flexible access to care, personally-tailored to individual need. Our group of roughly 1,500 people have contributed together and debated all of the issues. In the weeks ahead we will share our vision as a group for a better Medicare system.